Q: I keep getting panic attacks. How can I make them stop?
The counsellor says…
Panic attacks can be terrifying — your heart rate might quicken or you might become short of breath, then you have a sudden rush of extreme fear. Despite how it feels, panic attacks don’t cause any physical damage, and are usually over within five to 15 minutes. But for many people, a panic attack feels like a heart attack, and so they go to the hospital or visit a doctor. Once physical causes have been ruled out, it’s time to look at mental causes.
Sometimes there are specific reasons for panic attacks — familial link (a parent suffers); a pre-existing anxiety disorder; or post-traumatic stress (car accident) — but most often they happen without a direct link to cause.
Regardless of the reason a panic attack comes on, there are three strategies to help.
For PTSD sufferers, we would work through that experience and slowly re-expose them to what they’ve become afraid of. For everyone else, the strategy we start with is cognitive behavioural therapy (CBT). For many people, when they feel an early sign of a panic attack, they fear the worst, thinking that they’re having a heart attack or are about to faint. CBT teaches you to challenge those thoughts, asking “What evidence do you have that supports this belief?” Realizing that your panic attacks haven’t led to a heart attack or fainting in the past can reduce your anxiety about them, which in turn, lessens the severity of your symptoms.
The next strategy involves understanding the physiological responses behind the attack. That rapid heart rate is your body gearing up its fight or flight response to protect you against danger, but there is no real danger around. Knowing it’s a harmless innate response can help you calmly observe your symptoms.
Finally, grounding tools such as breathing exercises, counting objects in your environment or imagining a place where you feel happy and calm can help centre you. Try one of these at the earliest sign of an attack to prevent it from progressing. Some lifestyle changes can help reduce panic, such as limiting alcohol, because some people experience worse anxiety the day after consuming excess alcohol. Good sleep and exercise are also very important. Here are some more ways to help better manage your anxiety triggers.
Within eight to 10 sessions with a counsellor, many people see significant relief. If you don’t see improvement by then, you should be referred to your family doctor who can prescribe medication, such as an SSRI (selective serotonin reuptake inhibitor), which reduces anxiety and can prevent attacks. For some, it’s a winning combo of medication and counselling that helps them manage it — it’s an individual thing.
Noa Rabin is a registered clinical counsellor at Jericho Counselling Clinic in Vancouver.
The mindfulness expert says…
When a panic attack comes on, it seems to happen quickly, but there are usually some early warning signs. If you learn to recognize these, and do some mindfulness exercises in the early stages, you can help the episode of panic pass more quickly and be less intense. At our clinic, we offer mindfulness-based cognitive therapy training to help you learn some of these exercises, but mindfulness should be practised at home every day.
A key part of mindfulness training is learning to change your focus.
During the middle of a panic attack, you’re often focused on the worry, and the feelings that you’re having, but mindfulness is about being intentional about your attention, so you can turn your focus to where you want it, like your breathing or your surroundings.
Another important thing that mindfulness can teach you is to be an observer of your own experience without being caught up in it.
It’s clear that when we experience anxiety, we often start to worry about it, and this can compound the problem until we are having a full panic attack. Neutrally observing what we are experiencing opens things up so we don’t just automatically react. We may feel panic and want to bolt from the room, but we can train ourselves to notice those feelings, stay in the situation, and trust that the panic will subside. No emotion lasts forever, and your observations can help remind you that, even if you don’t feel OK right now, you will be. Of course, this is easier said than done, which is why it takes practice to train your brain to work this way.
A simple three-minute meditation that incorporates these principles can help many people at the onset of a panic attack.
You start by checking in with yourself internally: What are your thoughts and feelings right now? The next step is to focus on the sensations of your breathing, without changing your breathing. The final step is to expand your awareness and focus on the environment around you. Actively shifting your attention can help you feel in control and prevent further panic. Keep in mind, these medical conditions could also be triggering your anxiety.
Paul Kelly is a psychologist, and the clinical director and founder of The Mindfulness Clinic in Toronto.